This K05 proposal will support Dr. Schrag's efforts to train the next generation of health services researchers in cancer control and establish partnerships with state public health departments that leverage information from linkages between tumor registry, Medicaid and Medicare data. She will augment established linkages between these data sources in New York and California to evaluate quality and effectiveness of cancer care, identify priorities for intervention studies and pilot test feedback systems. Candidate Qualifications: Dr. Schrag is a medical oncologist and health services researcher and an Associate Professor of Medicine at Harvard Medical School. She also has an MPH from the Harvard School of Public Health. She has an accomplished research record, a current R01 directly relevant to the proposed work, and a successful teaching and mentorship track record. Career Development: Dr. Schrag seeks to enhance her already well developed health services research methods expertise through focused coursework in geospatial analysis and advanced pharmacoepidemiology. She seeks to cultivate her leadership skills to foster partnerships with state health departments and pursue externships to solidify these collaborations. Mentorship Objectives: Dr. Schrag proposes to dedicate 25% effort to mentorship and 10% to a complementary set of research projects that focus on care delivery for Medicaid insured cancer patients. She will train pre/postdoctoral students at Harvard, at neighboring institutions and in the New York State health department in health services research methods and quality improvement. Career Objectives: * To decrease the magnitude of disparities based on race and class by focusing on cancer care delivery for persons enrolled in Medicaid programs, the primary health insurer for Americans living in poverty. * To evaluate the effectiveness of new cancer treatments as they are used by patients living with challenges created by poverty and/or chronic disability. * To develop intervention strategies that improve cancer treatment for patients who have the largest gaps between actual and attainable treatment outcomes. * To develop sustainable strategic partnerships between providers (hospitals and physicians), researchers and health departments responsible for oversight of public insurance programs and population health. Research Project Objectives: Innovative, High Impact and Well Integrated with Mentorship Plans 1. Expand Capacity for Tumor Registry-Medicaid-Medicare Data Linkages to Evaluate Cancer Care * Update the NY and CA data linkages to include more recent cases with longer follow-up * Extend the NYS data linkages to include the pediatric population * Measure agreement between medical records and Medicaid administrative data * Develop tools that facilitate use of Medicaid data linkages by other investigators 2. Evaluate the Quality and Effectiveness of Care for Medicaid Recipients with Cancer * Evaluate use and outcomes of hormonal and chemotherapy for early stage breast cancer * Evaluate palliative care for patients with advanced solid tumors 3. Identify Specific Mechanisms that Explain Shortcomings and Design Interventions to Improve Care * Survey Medicaid enrollees about reasons for their underuse of care with known efficacy * Provide health care providers with data about care delivery for their Medicaid patients * Pilot capacity of feedback loops between NYS Medicaid, its enrollees and providers to improve care Environment: Dana-Farber/Harvard: The collaborative research program of the Dana-Farber/Harvard Cancer Center brings together seven institutions including the Harvard Schools of Medicine and Public Health. Dr. Schrag and her mentees have access to the wealth of resources at these institutions, including computing, space, training, cores, and expert research faculty. Research will be carried out in close collaboration with the New York State Department of Health's (NYSDOH) Cancer Registry and Medicaid leadership. The DFCI-NYSDOH partnership will take place via regular calls, webinars and trips to Albany, NY. Innovation and Impact: This work is innovative because it will develop an important but underutilized resource, train users and build its capacity as a launching pad for quality improvement. The proposed work is high impact because it will prioritize problems, identify solutions, and create sustainable infrastructure to improve care in NY, CA. This model can be adapted by other states invested in population health. PUBLIC HEALTH RELEVANCE: Over 60 million Americans, including many with complex needs, receive health insurance from state Medicaid programs. This project will build capacity for analyzing linkages between cancer registry, Medicare and Medicaid data in two populous states, New York and California. The candidate's commitment to mentoring will cultivate partnerships between researchers in academia and state health departments and will accelerate the identification and implementation of strategies to improve the quality and effectiveness of cancer care for our most vulnerable citizens.